Take Home Message: This study found that motivation and an
academic profile (SAT scores and high school GPA) are poor predictors of
neurocognitive and postural control scores in collegiate athletes; however, they
are related.

Neurocognitive
testing is a popular tool for concussion assessment, but many factors can
affect an athlete’s score, asides from a brain injury. Stress, irregular sleep patterns, caffeine,
time of day, motivation, and intelligence may be some variables affecting these
scores. By understanding how variables
like these influence neurocognitive testing we may be able to ensure that our
scores are informative. This study investigated the effects of motivation and
academic profile on baseline neurocognitive scores and postural control among 88
NCAA Division I college athletes. Academic profile’s consisted of SAT scores and high school grade point averages
(GPA), which the researchers retrieved from the admissions and registrar’s
offices. The researchers had issues
retrieving certain athlete’s information; therefore, 17 participants
self-reported these numbers. For
baseline testing, participants completed a neurocognitive test (CNS Vital Signs)
and a postural control assessment that involved a moving visual scene and force
plate. At the end of the testing session,
participants completed the paper-and-pencil Rey Dot Counting Test, which assesses
their motivation by determining how accurately and fast they can count dots on
cards. Results showed that motivation
and GPA predicted the processing speed standard score of neurocognitive
testing. Also, participants with higher
SAT scores tended to have higher complex attention domain standard scores. Lastly, participants with higher GPA and SAT
scores tended to have worse postural control scores. While these findings were statistically
significant it appears that motivation and academic profile only represent a
small percentage of the variability in neurocognitive or postural control
scores. Therefore, these variables may only
hold little meaning for baseline scores in the clinical realm.

Overall,
although little significance was found in this study, it brings to light
important variables that may influence baseline concussion test scores. Past research supported the idea that greater
motivation may be related to better neurocognitive testing scores (Bailey et al., 2006; Hunt et al., 2007), but in this
investigation the authors found that motivation was not sufficiently related to
the test scores to be a good predictor. However,
we need to recognize that low motivation and sandbagging, in which athletes
purposely perform poorly so as to easily achieve normal or better scores when
concussed, is a serious concern for safely returning athletes to play. To protect against adverse influences such as
these, understanding variables that can predict performance, such as academic
profile, could be very useful for practitioners. Furthermore, this could be
especially important in a setting, such as hospital, where baseline scores are
unavailable for comparison of post injury scores. This study may have had limitations, such as
low number of participants, poor scoring of the motivation test by the
researchers, lack of accuracy of high school GPA and SAT scores as
representation of their academic profile, which affected its results. Because these variables only accounted for a
small portion of the variability in these scores, there should be more exploration
into the other possible variables influencing these scores; however,
identifying all of these factors may be cumbersome considering these tests
could be influenced by so many factors. If
this is the case, and numerous variables other than concussion can influence
these scores, perhaps we need to reconsider the value we place on these tests.

Questions for
Discussion: What variables do you think relate
to baseline performance on concussion baseline tests such as neurocognitive
testing? Do you think an embedded motivation test in a neurocognitive test
would be useful? If neurocognitive and balance tests are influenced by a lot of
variables, like GPA, does this cause you to question their clinical value?

6
comments:

The purpose of research and out promise to continue to seek better knoelege and implement the best practices means that what we do will change. This being said, the huge amount of variables that may effect baseline scores does not mean that the testing is not cliniclay relavent. Baseline testing still gives us more of an idea about the athletes basic level of function and greaty improves our ability to make informed return to play decisions. Further research will likely improve our abilities to deal with the multitude of influencing factors, creating more effective testing, but the tests we have now are certainly better than what we have had in the past.

I do not think a motivational test should be inbeded into current testing with out a bit more research on its effect on scores. The impact test is already qite long and I worry that inceases in the test time will have negative effects on the athletes abilities to focus and stay motivated through out the test. This is especially true for younger athletes and those with learning diabilities.

Jake - I completely agree in that neurocognitive testing can still be a valuable tool when evaluating a concussion, especially because we have very limited objective assessments available to use for such an evaluation.

You also bring up a great point about how adding motivational testing to a neurocognitive test may increase the test time to the point where it may affect focus and motivation of the entire test. More research into motivation tests in this realm should definitely be performed to to see if this could be a viable or helpful option. If it further validates an athlete's score it could be incredibly helpful - maybe it would be more useful to use as a separate test from a neurocognitive test.

I think it’s important to understand this study was valuable in that it began to explore certain factors that may predict scores on a commonly used baseline concussion test. Perhaps the limitations of this study obstructed significant results from being found in these important elements. In the future, it may be of value to investigate some of the many other variables that could influence these scores and other baseline concussion tests. Of recent, hydration status and the amount of sleep received the night prior to a baseline test, have been explored.

Do you think motivation would increase if some sort of repercussions were placed on athletes? For example, being witheld from play if suspected of non-compliance or not performing to theri full ability in an IMPACT baseline test?

Introducing repercussions to ensure proper motivation and baseline testing scoring is an interesting concept. I believe athletes would take these baseline tests more seriously if they were withheld from play because of poor scores; however, I’m not sure if coaches and other athletics personnel would be willing to abide by these rules. Perhaps if the athletes were informed they would need to take these tests again, if they did not score appropriately, they would exhibit more motivation throughout the process. But then, because motivation and neurocognitive tests are separate entities, athletes could purposefully sandbag their baseline test while excelling at their motivation test. Clearly more investigation into the best way to administer these baseline tests, with the incorporation of motivation tests, should be performed.

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